Biochemical markers of neonatal sepsis: value of procalcitonin in the emergency setting

Abstract

Background We evaluated procalcitonin (PCT) assay in the emergency diagnosis of neonatal bacterial infection, especially in preterm infants, relative to C-reactive protein (CRP) and fibrinogen. Methods One hundred and twenty neonates (32 preterm), of whom 21 were infected, were tested. Results Concentrations of PCT, CRP and fibrinogen in uninfected infants were not affected by gestational age at birth. Concentrations of CRP and PCT increased rapidly during the first 24 h of life, while fibrinogen concentrations increased gradually from birth. All marker concentrations were significantly greater in neonates with bacterial infection. Receiver-operating characteristic analysis showed that optimum cut-off values for fibrinogen, CRP and PCT were 3.0 g/L, 7.5 mg/L and 2.5 µg/L respectively, for the diagnosis of sepsis at birth. Conclusions Determination of PCT is of value in excluding bacterial infection in neonates since it has a negative predictive value of 93%.